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A Wielgosz

Publications and source records attributed to A Wielgosz.

At least 19 recordsLinked to original sources
PubMed1997

Angiotensin-converting enzyme inhibition in myocardial infarction--Part 1: Clinical data.

There is an increasing body of clinical trial evidence to support the use of angiotensin-converting enzyme (ACE) inhibitors in the management of patients following myocardial infarction (MI). Enthusiasm for the use of ACE inhibitors in the acute phase of MI had previously been tempered by the adverse results of an early trial. However, exciting new information is available from several large, randomized studies that has not only quelled those initial concerns but also attests to the efficacy of using this class of medication in the first 24 h after an acute MI. A Canadian National Opinion Leader Symposium was held in November 1995 to review the results of the major ACE inhibitor clinical trials and to discuss key issues and controversies surrounding their use in acute MI. The focus of this paper, the first of two parts, is on the results of the major ACE inhibitor clinical trials.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Angiotensin-converting enzyme inhibition in myocardial infarction--Part 2: Clinical issues and controversies.

Over the past 10 years, several clinical studies have concluded that, in patients already receiving conventional therapies, angiotensin-converting enzyme (ACE) inhibitors further reduce the risk of death following myocardial infarction (MI). Post-MI ACE inhibitors have proven to be effective as long term therapy in high risk patients as well as when used for much shorter periods in a broad patient population. However, while considerable mortality data have been collected, the effects of ACE inhibitors post-MI on other cardiovascular outcomes have not been as well documented. In addition, a number of issues regarding the most effective use of these agents remain unresolved. This paper, the second of two parts, focuses on the clinical issues and controversies surrounding the use of ACE inhibitors following acute MI. The effects of ACE inhibitors on the outcomes of sudden death, nonsudden death, recurrent angina, mitral regurgitation and left ventricular dysfunction are reviewed and potential mechanisms of action are proposed. In addition, ACE inhibitor therapy is discussed in terms of patient selection criteria, choice of agent, optimal dosing regimen, concomitant use of other therapies and relative costs of treatment. Finally, potential mechanisms of action of ACE inhibitors are proposed for each of the outcomes examined.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

High refractive errors and the accident/incident rate in Canadian medical category 1 pilots.

BACKGROUND: Since 1982, the Canadian Civil Aviation Medicine Division has medically certified to Category 1 standard commercial and airline transport pilots whose visual correction was in excess of +/- 3.5 diopters (D). METHOD: A review between the years 1982 and 1991 of the 253 pilots who had been medically certified, although they were outside the standard, was conducted. We determined if there was any difference in the accident/incident rate in this group as compared with the Canadian general aviation population standardized to a rate per 100,000 flying hours. The 253 pilots were divided into two groups with Group A having a refractive error outside the range +/- 5.7 D and Group B having a refractive error range of +/- 3.5 to +/- 5.6 D. RESULTS: The Group A rate was within the expected range of accidents and incidents per 100,000 flying hours. The accident/incident rate in Group B was significantly lower than the expected average. CONCLUSION: In conclusion, the Canadian Civil Aviation Medicine Division's policy on granting "flexibility" to applicants with moderate to high refractive errors has not affected adversely the accident or incident rate and therefore has not compromised aviation safety.

Accidents, Aviation↗
PubMed1995

[Bacterial endocarditis in patients treated with maintenance hemodialysis].

UNLABELLED: Bacterial endocarditis (BE) is one of the most severe complications of hemodialysis (HD). The aim of the study was to analyse frequency and severity of BE in patients treated with HD in our dialysis unit. During the period 1969-1993276 patients were treated with HD in Gdańsk. In 23 cases (9F, 14M) HD treatment was complicated with BE. Patients were divided into two groups on basis of diagnostic criteria: I-13 patients (5F,8M) with BE diagnosed by means of clinical picture and positive blood culture.; II-10 (4F, 10M) with diagnosis additionally confirmed by echocardiography. In patients from group I BE was observed more often during the first 2 years of HD. In group II during 3-5 years of dialysis therapy, gram negative microorganisms were the most frequent etiological factors. The mean period of antibiotic therapy was 35 days. In all patients from group II changes in the bicuspid valve, in 60% of them additionally in aortic valve and in one patient also in the tricuspid valve were observed. In five patients changes in the parietal endocardium were also present. Development of organic valvular changes was observed in nine patients. Seven of 22 patients died during the acute phase of BE and two others from complications connected with BE. The longest survival of patients after BE was over 10 years. CONCLUSIONS: 1. The threat of BE in patients treated with HD decreased between 1987 and 1993 in comparison with the initial period of our HD station operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Development of renal transplantation in the Gdansk center].

The kidney transplantation is one of the renal replacement therapy methods, which prolongs live of the patients with the end stage renal disease for many years. Moreover, this method is well known, safe and not so expensive as dialysotherapy. Our purpose was to present the 15-year activity of the transplantation center in Gdańsk. The first renal transplantation took place on the 31st of March 1980 and there have been 137 renal transplantations in Gdańsk until now. We can divide the time between the 31st of March 1980 and the end of 1994 into two periods: I from 31.03.80 to 31.12.89 and II from 1991 to 1994. During the first were 46, and during the second were 91 renal transplantations performed. It means that since the second half of 1991 the activity of the center in Gdańsk has increased. The graft function was noted in 29 patients (63%) during the first period and in 75 (82%) during the second. The acute graft failure was observed in the most of the cases mentioned above. The 5-year living of the transplanted patients and the dialysed patients is comparable and amounts to 90%. Infections were the main reason of death during the first period, and cardiovascular complications during the second. The 5-year graft's functioning is 60%. Nowadays the results of the kidney transplantation center in Gdańsk are good and comparable with the results of other centers in Poland and Europe. Our center, as similar ones in Poland is prepared to extend the kidney transplantation activity. So it is necessary to intensify an effort to gain more organs for transplantations.

Cause of Death↗
PubMed1994

[Development of dialysis therapy in Poland during the decade 1984-1993].

Data concerning status of dialysis therapy in Poland during decade 1984-1993 were analysed. It was found that: 1. number of dialysis units increased two times (54-105), 2. number of dialysis stations raised 2.5 times (294-812), 3. number of patients treated with maintenance dialysis was increased 3.5 times (962-3783). These data showed dynamic development of this method of renal replacement therapy in Poland. However, in Poland acceptance rate dto dialysis therapy is still not satisfactory (30-35%). The Programme of the Country Committee for the Promotion of Nephrology based on the central founding system for the renal replacement therapy provides that by the end of 1995 it will be possible to treat 50% of patients with chronic uraemia. Continuous development of different methods of renal replacement therapy (hemodialysis, continuous ambulatory peritoneal dialysis, renal transplantation) is necessary for achieving possibilities compared with developed countries.

Health Promotion↗
PubMed1993

Patterns of recurrence and survival in AMI patients in Canada.

OBJECTIVE: To describe the patterns of recurrence and survival of patients following their first acute myocardial infarction (AMI). DESIGN: A retrospective follow-up study based on the population of Nova Scotia and Saskatchewan from 1981-85. SUBJECTS: The analyses were performed on patients aged 25 to 75 years (n = 2083) who had been admitted to hospital with their first AMI during 1981 from the provinces of Nova Scotia and Saskatchewan. MAIN RESULTS: The rate of recurrence of AMI was 10% in men and 7% in women, regardless of age. Median time to recurrence was 13 to 15 months in men and seven months in women. After the first AMI, mortality rates were higher in women one week and one month after the initial infarction, reaching statistical significance (only in the 55- to 74-year-old age group)--P < 0.01 and P < 0.02, respectively. Five-year mortality rates were significantly higher in the older age groups (P < 0.01), but were similar in men and women. CONCLUSIONS: Reinfarction occurs more quickly in women, who also appear to be at a higher risk of death during the first month, and especially during the first week, postinfarction.

Adult↗
PubMed1992

Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?

We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority.

Adult↗
PubMed1985

Medical education reduces inappropriate use of cimetidine in a teaching hospital.

Before and after an education program to improve appropriate prescribing of cimetidine in an 810-bed teaching hospital, all new prescriptions written during a 4-week period were investigated, and information was obtained as to the indications for use, the dosage and concurrent drug therapy. The prescriptions were judged appropriate or inappropriate according to indications for cimetidine approved by the Department of National Health and Welfare's Health Protection Branch. After the program 63% of the prescriptions were deemed appropriate, compared with 40% before the program. The proportion of patients at risk of drug interactions, however, remained virtually unchanged. The results suggest that medical education can reduce the inappropriate use of cimetidine in teaching hospitals.

Canada↗